• Ricarda Diem, Fanni Molnar, Flemming Beisse, Nikolai Gross, Katharina Drüschler, Sven P Heinrich, Lutz Joachimsen, Sebastian Rauer, Amelie Pielen, Kurt-Wolfram Sühs, Ralf Andreas Linker, Cord Huchzermeyer, Philipp Albrecht, Andrea Hassenstein, Orhan Aktas, Tanja Guthoff, Felix Tonagel, Christoph Kernstock, Kathrin Hartmann, Tania Kümpfel, Katharina Hein, Christian van Oterendorp, Birgit Grotejohann, Gabriele Ihorst, Julia Maurer, Matthias Müller, Martin Volkmann, Brigitte Wildemann, Michael Platten, Wolfgang Wick, Christoph Heesen, Ulrich Schiefer, Sebastian Wolf, and Wolf A Lagrèze.
• Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
• BMJ Open. 2016 Mar 1; 6 (3): e010956.

IntroductionOptic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function.Methods And AnalysisTreatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤ 0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33,000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months.Ethics And DisseminationTONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki, local laws and ICH-GCP.Trial Registration NumberNCT01962571.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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